I recently studied the malpractice claims experience of the AAPA endorsed insurance program from 1987 to 2001, reflecting more than $30 millin of incurred claims.This was the period insured by the MMI Companies. Because claims develop over time, only by looking back several years can we draw any conclusions about trends in malpractice. For example, there is still active litigation on claims against policies written in 1992. Technically, a new claim could be reported against such a policy today or tomorrow. However, the greater the time since a given policy year, the less likely there will be further development of incurred claims.

In policy year 1992, the average payment to claimants was $31,990. This may seem like a relatively small number, but it is an average; while many claims may close out for only a few hundred dollars of legal expenses, there are others that reach high six figures. In 1999, though, the average was $136,937, a 428 percent increase, or a 23 percent increase per year over the seven-year period. The actual -number of claims remained virtually the same, 41 in 1992 and 48 in 1999. The number of PAs participating in the program was relatively constant over this period.

PAs are not being sued more often, but each lawsuit costs a lot more.
This is not unique to PAs. Median jury awards for all malpractice cases, mostly against physicians and hospitals, rose 211 percent between 1996 and 2000. Average PA claim payments rose 194 percent during that period: virtually the same. So there is good and bad news. PAs are not the leading edge in the escalating trend of malpractice payouts, but PAs are caught in the same wave of skyrocketing costs as physicians and the general health care world. That's why their malpractice premiums are going up.

The good news: PAs are not sued as often as are physicians. You have about a two percent chance of being sued in a given year. But aside from the numbers, why are PAs sued? The reasons are as varied as the treatment options and settings in which PAs work. However, one generic category stands out: failure to diagnose and/or refer (FTD). This can mean anything from sending a patient home with Maalox to treat indigestion (myocardial infarction a few hours later) to suturing an infant's eyelid laceration and releasing the infant without an ophthalmic evaluation (permanent blindness in that eye). Unfortunately, these were actual cases.

We are working to identify what within this broad category can be addressed through education to reduce the incidence of FFD claims. Interestingly, of the top 20 claim payouts from the period studied, three were related to pulmonary embolisms. Conventional wisdom had been that cancer and MI were the biggest problem areas. We are also looking at whether the number of years of experience of the PA or other factors correlate with the incidence of claims. We are working to find the ways to reduce the number and severity of claims. And none too soon - the first $1 million malpractice payout on behalf of a PA was made recently. A few more payouts of that magnitude and it will be hard to arrest the trend of PA claims and consequential increases in PA premiums.

One thing that you can immediately do to potentially reduce claims is take the on-line course Patient Com- munications and Adverse Outcomes. It gives you the tools to communicate with patients in a way that may dissuade your patient from suing you in the first place. It qualifies for CME credit and a 10 percent discount off your insurance premium if you participate in the AAPA-endorsed profes- sional liability insurance program.

You can access the course at www. epreceptor.com/aapa.
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